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Cultural Competent Health Care

Cultural Competent Health Care. Shrink the Earth’s Population to 100. 57 Asians 21 Europeans 14 North, Central and South Americans 8 Africans 70 would be non-white, 30 white 70 would be non-Christian, 30 Christian. Year 2000 Whites – 69.4% Black – 12.7% Hispanic – 12.6% Asian – 3.8%.

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Cultural Competent Health Care

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  1. Cultural Competent Health Care

  2. Shrink the Earth’s Population to 100 • 57 Asians • 21 Europeans • 14 North, Central and South Americans • 8 Africans • 70 would be non-white, 30 white • 70 would be non-Christian, 30 Christian

  3. Year 2000 Whites – 69.4% Black – 12.7% Hispanic – 12.6% Asian – 3.8% Year 2050 Whites – 50% Black – 14.6% Hispanic – 24.4% Asian – 8% Population in the U.S. US Census Bureau, 2004

  4. Registered Nurses in the U.S.(2000) • 86.6% - non-Hispanic white (US dept of Health & Human Service, 2003)

  5. Population in San Jose (2000) • Whites - 47.5% • Hispanic - 30.2% • Asian - 26.9% • Black - 3.5% U.S. Census Bureau (2006)

  6. Languages speak in U.S • Number of bi- or multilingual population - nearly 50 million • 2005 Census Bureau American Community Survey • 80% - speak English • 12% -speak Spanish • 4% - speak other Indo-European languages, ie French, German, and Russian

  7. Languages speak globally • Central Intelligence Agency’s World Fact book for 2007 • 5% speak Spanish • 4.9% speak English • 14% speak Mandarin Chinese • Need for second or third language within 20 years

  8. Minorities Receive Lower Quality Health Care Than Whites • Institute of Medicine, 100 studies reviewed over past 10 yrs. • Full report www.nap.edu/books/030908265X/html • Minorities less likely to receive sophisticated Txs for AIDS • More likely to have leg amputations for diabetes • Poorer relationships with MDs

  9. Other Cultural Domains • Folk beliefs/religion - can be confused with “religiosity” • Stereotyping labels - avoid generalizations • Ethnopharmacology - genetic influence, effect, metabolism • Herbal therapies - interactions with meds • Folk healers & treatment approaches, e.g.., hysteria, psychosis

  10. Cultural competence &impact on clinical outcomes • Patients fear of being misunderstood or disrespected; • Providers are not familiar with the prevalence of conditions among certain minority groups • Providers may fail to take into account differing responses to medication • Providers may lack knowledge about traditional remedies, leading to harmful drug interactions • Patients may not adhere to medical advice because they do not understand or do not trust the provider; • Providers may order more or fewer diagnostic tests for patients of different cultural backgrounds

  11. Ethnic disparities in health care • African American women are more likely than European American women to die from breast cancer, despite having a lower incidence of the disease. • Infant mortality rates are 2.5 times greater for African Americans and 1.5times greater for Native Americans than for European Americans. • Influenza death rates are higher for African Americans and American Indian/Alaska Natives/Native Alaskans than they are for European Americans. • Mortality for colorectal cancer is highest for African Americans, followed by Native Alaskans, and then Hawaiians.

  12. Needs for cultural competence • American nurses experienced a lack of cultural confidence in caring for culturally diverse populations - Coffman, Shellman, & Bernal (2004) and Hagman (2006) • There were gaps in healthcare providers’ knowledge of other cultures and how to care for them in culturally sensitive ways - Jones, Cason, and Bond (2004)

  13. Other evidences • Negative racial stereotypes - rate black patients as more likely to abuse drugs and alcohol, less likely to comply with medical advice, and less likely to participate in cardiac rehab than white patients - Van Ryn and Burke (2000) • Less Dx test - physicians were less likely to recommend catheterization procedures for black female patients than white or black male patients if they experienced the same kind of symptoms. Schulman et al. (1999)

  14. Cultural competence is a process • American Nurses Association published its first guidelines on cultural diversity in nursing curricula in 1986 - understanding the concept of human diversity including cultural and racial variations • The Board of Registered Nursing of California (2006) has required all nursing schools in California to include cultural diversity and competence into their curricula

  15. Language barriers and disparity • Utilization of health care services • Fewer doctor visit and less preventive services • More diagnostic test to compensate communication problems • Satisfaction • Less satisfied unless with interpreter • Adherence • Miss the appointment or drop out • Outcomes • Patient education

  16. Health Disparities • President Clinton (1998) set the goal – reduce health disparities by the year 2010. • Target areas: (NIH, 2003) • Infant mortality, • Cancer screening and management, • Cardiovascular disease, • Diabetes, • HIV/AIDS, • Immunization

  17. Problems with Health Disparities- with cultural factors Flaskerud, J. et al (2002) – a review of 79 articles in the past 5 decades: • Ignorance of certain groups (indigenous peoples) • Inappropriate lump together ie. Hispanic members of disparate groups with their own cultural identity eg., Puerto Ricans, Mexicans, Cubans, Dominicans

  18. Aday’s 2010 Priorities Showcase – Needs within vulnerable population • High-risk mothers & infants-of-concern • Chronically ill & disabled • Persons living with HIV/AIDS • Mentally ill & disabled • Alcohol & other substance abuses • Suicide- or homicide-prone behavior • Abusive families • Homeless persons, • Immigrants/refugees

  19. Impact of Cultural Competency • More successful patient education • Increases in pt’s health care seeking behavior • More appropriate testing and screening • Fewer diagnostic errors. • Avoidance of drug complications • Greater adherence to medical advice • Expanded choices and access to high-quality clinicians.

  20. Culture - Bound Syndromes • A person living within a certain reality • Learned way to interpret the world based on enculturation • Recurrent, locality- specific patterns of aberrant behavior and troubling experiences that may not be linked to a DSM-IV diagnosis

  21. Culture Bound Syndromes

  22. Culture Bound Syndromes Cont.

  23. Culture Bound Syndromes Cont.

  24. Culture Bound Syndromes Cont.

  25. Temporal Relations • Time Orientation • Past, present or future-oriented • Punctuality • Desi time • Color people time • Rubber band time

  26. Negotiation Process • Listen: to the client’s perspective • Teach: from your knowledge in language appropriate for client & family • Compare: similarities & differences, disagree but do not devalue client’s view • Compromise: • if client treatment not harmful, promote • If harmful, explain harm and suggest alternatives

  27. The Health Promotion Matrix Gorin, S. & Arnold, J. (1998). Health Promotion Handbook. St Louis: Mosby. P 92

  28. Embracing Diversity

  29. Ladder of inference Action Feeling & emotion Beliefs and attitude Perception & assumptions

  30. Similarity Vs. Differences • Assumptions = truth • Inherited traits • Ways of capture, store, & retrieve information • More likely when time & information are limited • Subconsciously discriminate • Race > gender > age

  31. Stereotypes • Mental shortcut • Based on limited knowledge/experience • More likely • Multitasking • Anxious • Have to make quick decision • Pressed for time • generalization

  32. Generalization • Based on common trends among groups • Need information to determine if person fits the group/category • It is a starting point

  33. Challenges • Language barrier • Accents, sang, dialects, familiarity with English, speed • Literary barriers • Different belief or perceptions • Culture • Decision maker/communication roles, communication styles, culture values • Trust

  34. Culture and communication High context ………..…..Low context Egalitarian …...………… Hierarchical Individualist ……...………collectivist Relationship ……………….……Task Monochronic …………….polychronic Harmony ……………….. differences

  35. Strategies to embrace diversity • What have worked ? • What has not worked ? • Individual level • Organization level

  36. Reasons for embracing diversity • Individual reason • Unit reason • Organization reason

  37. Discussion • How diversity can promote partnership and shape conflict? • Strategies for improving cross-cultural communication? • Is it a heart work, head work, or hand work?

  38. Before Next Class • Take extra care of yourself and your family • Trisha’s 3 article review and chapter 5 of deChesnay • Trisha’s presentation on Navajo. • Presentation list is posted at Blackboard • Pick your group and the topic for group presentation. If you have ppt, send it to atn@sjsu.edu one week before your presentation; limit slides to 30 • Have a great week

  39. The End

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